系统干预促进抗菌药物合理使用的调查分析

Review of the Systematic Interventions in Promoting Rational Use of Antibiotics

目的:探寻影响抗菌药物使用的决定因素,提出促进合理使用抗菌药物的政策建议。方法:收集2000-2009年间,世界卫生组织和卫生部支持的,在我国7个省市三级甲等医院中开展的,针对清洁手术预防性使用抗菌药物的系统干预项目并综述干预结果,对影响抗菌药物合理使用的决定因素进行定性分析与总结。结果:清洁手术预防性使用抗菌药物,有适应证用药总体合理程度在所有干预项目实施后均有显著改善;无适应证用药改善不明显,持续处于高位。结论:多方面影响因素决定医师如何使用抗菌药物,包括医疗设施和卫生条件、学术环境、专业知识和技能、用药指南的可操作性、用药监管力度、法律和社会环境双重压力下的自我保护意识、患者期待、卫生系统的负面激励等。促进合理使用抗菌药物需要医学教育部门、医药监管部门、医患双方和社会各界协同努力,树立科学发展观和重视人文关怀。

OBJECTIVE： To analyze the definitive influencing factors of antibiotics use, and to provide suggestion for rational use of antibiotics. METHODS： The reports of all the WHO-MoH supported systematic intervention projects on prophylactic application of antibiotics in clean surgery were collected from class three grade A hospitals of 7 provinces in China during 2000-2009. According to results of intervention projects, the definitive influencing factors of antibiotics use were analyzed qualitatively. RESULTS： The overall rationality of preventive antibiotic use in indicated clean surgery was improved following planned interventions, but there was limited effect on reducing the rate of antibiotic prophylaxis for non-indicated clean surgery. CONCLUSION：Multi-factors determine the antibiotic use behaviors of physicians, including medical facilities and hygiene conditions,academic environment,professional knowledge and skills,operationally of the guideline,regulation intensity,self-protection from unexpected complains and sues under legislative and social pressure,patients’ expectation,and perverse incentives in the health systems,etc. There is a need of joint efforts in promoting rational use of antibiotics by the medicine education sector,medicine supervision authority, hospitals and patients, and all relevant stakeholders to set up the concept of scientific development and humanism care.